Prevalence of Hepatitis B Virus infection in the Gulf Cooperation Council: a systematic review and meta-analysis.

BACKGROUND: Hepatitis B virus (HBV) infection is a global public-health problem. Since the introduction of an effective vaccine, the epidemiology of HBV infection is changing. We aimed to estimate the prevalence of HBV infection in the Gulf Cooperation Council (GCC) region and delineate any variation in member-countries, special sub-groups, and over time. METHODS: This is a systematic review and meta-analysis to review studies of HBV prevalence in the GCC region. Databases were searched and all studies from inception to July 31st, 2021, were considered for inclusion. The pooled HBV prevalence was analyzed using the random-effect model after assessment for heterogeneity. True prevalence was adjusted using the Rogan-Gladen estimator. Pre-defined subgroup analysis was performed, and publication bias was assessed. RESULTS: Overall, 99 studies (n = 1,944,200 participants) met the inclusion criteria. The overall HBV apparent prevalence was 3.05% (95% CI 2.60, 3.52) and the true prevalence was 1.67% (95% CI 1.66, 1.68). The apparent prevalence varied between subgroups. Over time, the apparent prevalence of HBV infection has declined from 9.38% (95% CI 7.26, 11.74) before 1990 to 1.56% (95% CI 1.07, 2.12) during the period 2010 to 2020. CONCLUSION: Over the last four decades the overall prevalence of HBV infection in the GCC region has decreased from high- to low-endemicity level. However, due to poor methodology of the included studies, further high-quality community-based studies are needed to obtain more precise estimate of HBV infection in this region.

Seroprevalences of Toxoplasma gondii and Neospora caninum infections in Jordanian women who had a recent spontaneous abortion.

This cross-sectional study investigates Toxoplasma gondii and Neospora caninum among 445 recently spontaneously aborted (RSA) Jordanian women using ELISA and indirect fluorescent antibody (at a cut-off value of 1/200) tests, respectively. The type of hospital, age, cat and dog contacts, raw and barbecued meat and wild plant consumption, number of abortions, and stillbirths were tested as independent variables using univariate and multivariate logistic regression analyses. The true seroprevalences were 22.1% for T. gondii-IgG, 22.7% for N. caninum-IgG, 2.6% for T. gondii-IgM, 10.6% for N. caninum-IgM, 0% for T. gondii-IgG and IgM, 6.7% for N. caninum-IgG and IgM, and 4.6% and 0% for both parasite IgG and IgM, respectively. T. gondii-IgM-seropositivity was associated with the number of abortions with odds ratios (OR) of 2.4 and eating barbecued meat (OR = 0.12). N. caninum-IgG-seropositivity was associated with having a dog in the house (OR = 2.6), and with stillbirth (OR = 0.1). N. caninum-IgM was associated with visiting a private-hospital (OR = 2.7). RSA Jordanian women are equally exposed to both parasites with significantly (p < 0.05) higher seroprevalence of N. caninum-IgM compared to T. gondii-IgM suggestive of active infections among RSA women in Jordan.

Congenital abnormalities in dead-in-shell chicks associated with mixed bacterial infections.

Determination of the chick embryonic developmental period at which embryonic mortalities occur could help in establishing the cause of such mortalities. The late stage of embryonic development has particular importance due to its dramatic effect on life after hatching. This study was conducted to investigate the occurrence, frequency and bacterial isolates from dead-in-shell chick embryos in Northern Jordan. A total of 1,000 unhatched eggs were collected at hatching day from 10 hatcheries located in Northern Jordan. Out of 1,000 eggs, 357 (35.7%) were fertile, of which 210 (58.8%) were dead-in-shell embryos. Approximately 50.5% of the dead embryos displayed abnormalities, including neck muscles with subcutaneous petechial haemorrhages (44.3%), beak abnormalities (3.8%), eye deformities (1.9%) and anencephaly (0.5%). Sixty-six bacterial isolates were identified from 82 samples from the dead-in-shell embryos. The isolates were 22 (33.3%) Escherichia coli, 18 (27.3%) Klebsiella pneumoniae, 14 (21.2%) Staphylococcus aureus, 5 (7.6%) Pseudomonas aeruginosa, 4 (6.1%) Salmonella enteritidis, 2 (3%) Bacillus cereus and 1 (1.5%) Proteus vulgaris. Mixed growth was also recorded in 16 (19.5%) samples. There was a significant (P < 0.05) association between Escherichia coli as a bacterial isolate and the occurrence of neck and beak abnormalities. In this study, infection of check embryos with several bacterial species, particularly Escherichia coli, was identified as an important cause of multiple congenital abnormalities involving the neck and beak of unhatched chicks.

Seroprevalences of Toxoplasma gondii and Neospora caninum infections in Jordanian women who had a recent spontaneous abortion / Soroprevalências de infecções por Toxoplasma gondii e Neospora caninum em mulheres jordanianas que tiveram um aborto espontâneo recente

Abstract This cross-sectional study investigates Toxoplasma gondii and Neospora caninum among 445 recently spontaneously aborted (RSA) Jordanian women using ELISA and indirect fluorescent antibody (at a cut-off value of 1/200) tests, respectively. The type of hospital, age, cat and dog contacts, raw and barbecued meat and wild plant consumption, number of abortions, and stillbirths were tested as independent variables using univariate and multivariate logistic regression analyses. The true seroprevalences were 22.1% for T. gondii-IgG, 22.7% for N. caninum-IgG, 2.6% for T. gondii-IgM, 10.6% for N. caninum-IgM, 0% for T. gondii-IgG and IgM, 6.7% for N. caninum-IgG and IgM, and 4.6% and 0% for both parasite IgG and IgM, respectively. T. gondii-IgM-seropositivity was associated with the number of abortions with odds ratios (OR) of 2.4 and eating barbecued meat (OR = 0.12). N. caninum-IgG-seropositivity was associated with having a dog in the house (OR = 2.6), and with stillbirth (OR = 0.1). N. caninum-IgM was associated with visiting a private-hospital (OR = 2.7). RSA Jordanian women are equally exposed to both parasites with significantly (p < 0.05) higher seroprevalence of N. caninum-IgM compared to T. gondii-IgM suggestive of active infections among RSA women in Jordan.

Resumo Este é um estudo transversal, investigando Toxoplasma gondii e Neospora caninum entre 445 mulheres jordanianas recentemente abortadas espontaneamente (RSA), usando-se ELISA e testes de anticorpos fluorescentes indiretos (com valor de corte de 1/200), respectivamente. Tipo de hospital, idade, contato com o cão, consumo de carne, número de abortos foram testados como variáveis independentes, usando-se análises de regressão logística univariada e multivariada. As verdadeiras seroprevalências foram 22,1% para T. gondii-IgG; 22,7% para N. caninum-IgG; 2,6% para T. gondii-IgM; 10,6% para N. caninum-IgM, 0% para T. gondii-IgG e IgM, 6,7% para N. caninum-IgG e IgM, e 4,6% e 0% para ambos os parasitas IgG e IgM, respectivamente. A soropositividade para T. gondii-IgM foi associada ao número de abortos com "odds ratio" (OR) de 2,4 e ingestão de carne grelhada (OR = 0,12). A soropositividade para N. caninum-IgG foi associada à presença de cachorro em casa (OR = 2,6) e natimorto (OR = 0,1). N. caninum-IgM foi associada à visita a um hospital privado (OR = 2,7). Mulheres jordanianas com RSA estão igualmente expostas a ambos os parasitas com soroprevalência significativamente (p <0,05) maior de N. caninum-IgM, em comparação com T. gondii-IgM, sugestivo de infecções ativas entre mulheres com RSA na Jordânia.

Antimicrobial resistance among GLASS pathogens in conflict and non-conflict affected settings in the Middle East: a systematic review.

BACKGROUND: In spite of the evident general negative effects of armed conflict on countries' health systems and populations' health outcomes, little is known about similar impacts of conflicts on the spread of antimicrobial resistances (AMR). This review was to address this evidence gap and describe: 1. Patterns of AMR in the Middle East (ME) and resistance profiles of pathogens included in the Global AMR Surveillance System (GLASS) supported by the World Health Organization; 2. Differences in proportions of AMR isolates between conflict and non-conflict countries. METHODS: A systematic literature review was conducted following PRISMA guidelines and searching five electronic databases. Subject heading and free text were searched for "antimicrobial resistances" and "Middle East", to identify observational studies on AMR published from January 2011 to June 2018. Data were extracted from included articles on a predefined set of variables. Percentages of AMR were analysed as median and interquartile ranges. Risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS: A total of 132 articles met the inclusion criteria. Included studies showed heterogeneity in study design, laboratory methods and standards for interpretation of results, and an overall high risk of bias. Main findings were the following: 1. High proportions of carbapenem resistance in Acinetobacter spp. (median 74.2%), and both carbapenem resistance (median 8.1 and 15.4% for E. coli and K. pneumoniae respectively) and ESBL-production (median 32.3 and 27.9% for E. coli and K. pneumoniae respectively) amongst Enterobacteriaceae. S. aureus isolates showed a median methicillin resistance percentage of 45.1%, while vancomycin resistance was almost absent. A median of 50% of the strains of S. pneumoniae showed non-susceptibility to penicillin. 2. Similar trends were observed in conflict and non-conflict affected countries. CONCLUSIONS: There is a lack of standardization in the methodological approach to AMR research in the Middle East. The proportion of antibiotic resistances among specific GLASS pathogens is high, particularly among Acinetobacter spp.

Age, gender and climate associations with the seroprevalence of Neospora species infection in horses in Jordan.

A cross-sectional study was carried out on a sample of 379 horses to determine the seroprevalence of Neospora spp. in Jordan using the indirect fluorescent antibody test. Five variables, namely locality (n=10), climatic zone (n=4), age group (n=3), gender, and breed were tested as risk factors for Neospora-immunoglobulin (Ig)G seropositivity at four cutoff titers (1:50, 1:200, 1:400, and 1:800) using univariate and multivariate logistic regression analyses. A total of 122 (32%; 95% CI: 28, 37) sera samples had anti-Neospora-IgG at a cutoff titer of 1:50. Increased Neospora-IgG seropositivity was found in horses in three localities (Madaba, Zarka, and Petra) and was associated with the following variables: cool temperate climate; age >14 years; and female gender. Seropositivity was found among horses from Madaba at all cutoff titers, Zarka at titers >1:200, and Petra at titers <1:200. Cool temperate climate was associated with titers <1:400. Horses aged >14 years were found to be associated with seropositivity at titers ≥1:200. Female gender was associated with high seropositivity at >1:800.

Age, gender and climate associations with the seroprevalence of Neospora species infection in horses in Jordan / Idade, sexo e associações climáticas com a soroprevalência da infecção por Neospora em cavalos da Jordânia

Abstract A cross-sectional study was carried out on a sample of 379 horses to determine the seroprevalence of Neospora spp. in Jordan using the indirect fluorescent antibody test. Five variables, namely locality (n=10), climatic zone (n=4), age group (n=3), gender, and breed were tested as risk factors for Neospora-immunoglobulin (Ig)G seropositivity at four cutoff titers (1:50, 1:200, 1:400, and 1:800) using univariate and multivariate logistic regression analyses. A total of 122 (32%; 95% CI: 28, 37) sera samples had anti-Neospora-IgG at a cutoff titer of 1:50. Increased Neospora-IgG seropositivity was found in horses in three localities (Madaba, Zarka, and Petra) and was associated with the following variables: cool temperate climate; age >14 years; and female gender. Seropositivity was found among horses from Madaba at all cutoff titers, Zarka at titers >1:200, and Petra at titers <1:200. Cool temperate climate was associated with titers <1:400. Horses aged >14 years were found to be associated with seropositivity at titers ≥1:200. Female gender was associated with high seropositivity at >1:800.

Resumo Um estudo transversal foi realizado, na Jordânia, em uma amostra de 379 cavalos, para determinar a soroprevalência de Neospora spp., usando-se o teste de anticorpos fluorescentes indiretos. Cinco variáveis: localidade (n=10), zona climática (n=4), grupo etário (n=3), sexo e raça, foram testadas como fatores de risco para soropositividade para Neospora-imunoglobulina (Ig)G, considerando-se quatro pontos de corte (1:50, 1:200, 1:400 e 1:800) por meio de análises de regressão logística univariada e multivariada. Um total de 122 (32%; 95% CI: 28, 37) amostras de soros apresentaram anti-Neospora-IgG, utilizando-se como ponto de corte o título de 1:50. Cavalos de três localidades apresentaram aumento da soropositividade para Neospora-IgG (Madaba, Zarka e Petra) o que foi associado às seguintes variáveis: clima temperado fresco; idade >14 anos; e sexo feminino. Os cavalos de Madaba apresentaram soropositividade em todos os títulos utilizados como ponto de corte; os cavalos de Zarka em títulos >1:200; e os cavalos de Petra em títulos <1:200. O clima temperado fresco foi associado aos títulos <1:400. Cavalos com idade >14 anos estiveram associados à soropositividade nos títulos ≥1:200. O sexo feminino esteve associado à alta soropositividade nos títulos >1:800.

Knowledge, Attitudes, and Practices Associated with Brucellosis in Livestock Owners in Jordan.

We evaluated livestock owners' knowledge, attitudes, and practices regarding brucellosis in Jordan. A questionnaire was administered and biological samples were examined to verify the serological status of animals. Seroprevalence estimates indicated that 18.1% (95% CI: 11-25.3) of cattle herds and 34.3% (95% CI: 28.4-40.4) of small ruminant flocks were seropositive. The results showed that 100% of the interviewed livestock keepers were aware of brucellosis: 87% indicated a high risk of infection if unpasteurized milk is consumed and 75% indicated a high risk if unpasteurized dairy products are consumed. Awareness of the risk of infection through direct contact with fetal membranes or via physical contact with infected livestock is considerably lower, 19% and 13%, respectively. These knowledge gaps manifest in a high frequency of high-risk practices such as assisting in animal parturition (62%), disposing aborted fetuses without protective gloves (71.2%) or masks (65%), and not boiling milk before preparation of dairy products (60%). When brucellosis is suspected, basic hygiene practices are often disregarded and suspect animals are freely traded. Public health education should be enhanced as the disease is likely to remain endemic in the ruminant reservoir as long as a suitable compensation program is not established and trust on available vaccines is regained.

Herd- and individual-level prevalences of and risk factors for Salmonella spp. fecal shedding in dairy farms in Al-Dhulail Valley, Jordan.

Salmonellosis is an important disease frequently associated with diarrhea in calves. From January to September 2009, a cross-sectional study involving 91 dairy farms was conducted to determine the prevalence of Salmonella spp. infection in cattle in Al-Dhulail Valley, Jordan. A total of 910 calve and cow fecal samples were collected. Information on farm management practices was obtained through personal interviews using a standardized questionnaire and was tested as risk factors for Salmonella spp. positivity in farms by using logistic regression analysis. Standard conventional methods for Salmonella isolation and serotyping were used, and the disk agar diffusion test was used for antimicrobial testing. The herd-level prevalence of Salmonella spp. in calves, cows, and dairy farms was 12, 12, and 23 %, respectively, and the individual-level prevalence was 4 % for calves, cows, and dairy farms. Forty-six percent of the dairy farms had calf diarrhea, and 4 % had cow diarrhea. Seven (17 %) of the 42 farms with calf diarrhea had Salmonella. However, only 7 % (95 % CI: 4, 10) of the 221 diarrheic and 1 % (95 % CI: 0.2, 4) of the 234 of non-diarrheic calves had Salmonella. A total of 33 Salmonella isolates were obtained from the fecal samples: 12 isolates were Salmonella typhimurium, 6 were Salmonella montevideo, 6 were Salmonella anatum, 2 were Salmonella enteritidis, and 7 isolates were not serotyped. All isolates were susceptible to ciprofloxacin, trimethoprim-sulfamethoxazole, gentamycin, neomycin, colisitin, and amoxicillin at 100, 91, 85, 79, 79, and 70 %, respectively. Out of the 11 variables/categories, the frequency of cleaning every 2 months or more was associated with high odds of infection among calves (OR = 5.6) and farms (OR = 7.0).

Seroprevalence of and risk factors for Mycoplasma mycoides subspecies capri infection in small ruminants in Northern Jordan.

During the period from January 2002 to December 2003, serum samples were collected from 104 small ruminant flocks consisting of 18 sheep flocks, 27 goat flocks, and 59 mixed flocks containing both sheep and goats in northern Jordan. Only female sheep and goats were sampled. At least five females aged over 2 years per flock per species were sampled and examined for Mycoplasma mycoides subspecies capri using the latex agglutination test. To increase the chances of detecting positive flocks, sick or older ewes were sampled. Specific information was obtained using a questionnaire to identify potential risk factors for M. mycoides subsp. capri seropositivity in small ruminants. The true flock-level seroprevalences of M. mycoides subsp. capri were 34%, 32%, and 38% in small ruminants (sheep and goats), sheep, and goats, respectively. Differences between flock-level seroprevalences in sheep and goats were not significant (p = 0.7). Multivariable logistic regression analysis of 21 production and health management practices showed four to be associated with M. mycoides subsp. capri seropositivity including flocks which were grazed and fed concentrate supplement (OR = 4.6), improper cleaning of milking utensils (OR = 4.7), buying new animals to replace culled ones (OR = 0.3), and treating against helminths when clinical signs of helminth infections appear (OR = 0.4).

Flock-level seroprevalence of, and risk factors for, Neospora caninum among sheep and goats in northern Jordan.

During the period January 2002 to December 2003, serum samples were collected from 104 small ruminant flocks consisting of 18 sheep flocks, 27 goat flocks and 59 mixed flocks containing both sheep and goats in northern Jordan. Only female animals were sampled. At least 5 females aged over 2 years per flock per species were sampled and examined for anti-Neospora caninum antibodies using ELISA. To increase the chances of detecting positive flocks, sick or older ewes were sampled. Also, N. caninum DNA was investigated in 7 sheep brains using PCR technique and 1 was found positive. The flock-level true seroprevalence in small ruminants was 53% (95% CI: 43,63). The true flock-level seroprevalence was higher in sheep (92%) than goats (12%) (OR=55; 95% CI: 17,197). Similarly, the individual-level seroprevalence in sheep and goat was 63% and 2% respectively (OR=25; 95% CI: 16,39). Out of 32 production and health management variables, the presence of dogs with the flock (OR=3.6, 95% CI: 1.2,10) enhanced seropositivity. Cold temperate climate (OR=0.1, 95% CI: 0.03,0.4), veterinary supervision (OR=0.2, 95% CI: 0.06,0.6) and buying healthy animals to replace those culled (OR=0.3, 95% CI: 0.1,0.97) reduced the risk of seropositivity. Both sheep and goats in Jordan are exposed to N. caninum infection with higher seroprevalence in sheep than goats. The contribution of N. caninum to abortion in small ruminant flock needs to be evaluated. Educating the farmers with regard to the role of dogs in transmitting N. caninum infection is expected to enhance small ruminant health in Jordan.

Risk factors associated with Mycoplasma agalactiae infection of small ruminants in northern Jordan.

Serological detection of Mycoplasma agalactiae was carried out in 104 small ruminants flocks consisting of 18 sheep, 27 goat and 59 flocks containing both sheep and goats in northern Jordan between 2002 and 2003. At least 5 serum samples per flock were tested using an indirect ELISA for antibodies to M. agalactiae. To increase the chances of detecting this mycoplasma, sick or older animals were sampled. A high seropositivity to M. agalactiae was found in small ruminants suggesting a major role for M. agalactiae in contagious agalactia in northern Jordan. There was no significant difference in the seroprevalence of M. agalactiae in sheep and goats at flock level (X(2)=0.14, d.f.=1, p=0.7). A total of 31 variables including production and health management practices were tested as risk factors for seropositive flocks and analyzed using logistic regression analysis. Increasing risk factors for M. agalactiae seropositive flocks were: using outsider rams, improper cleaning of the milking utensils and separating young from dam, with odds ratios of 5, 3, 4.2, respectively; having mastitis problems in the flock was negatively associated (p=0.04) with M. agalactiae seropositivity. Educating small ruminant farmers to avoid the use of outsider rams, ensuring adequate cleaning of milking utensils and separating the young from dams would enhance the health of small ruminants.

Przhevalskiana silenus myiasis among slaughter goats in northern Jordan.

During the period December 1998-May 2000, 900 local goats slaughtered at the Irbid Abattoir (northern Jordan) were examined for the larval instars of Przhevalskiana silenus. Of 900 goats, 10% (95% CI: 9,13) were infested with P. silenus larvae. Only the second and third larval instars were seen. A multiple-regression analysis (with the error variance described by the negative-binomial function) suggested that infestation depended on the month of sampling, and that infestation with live larvae was associated with a poorer carcass. The percentage of infested goats and the mean monthly total number of larvae per goat peaked in samples taken in the autumn and winter. Larval numbers were highly aggregated: most animals had no larvae but the maximum was 69. Analysis of the pattern of aggregation suggested that the best model fit was one in which the larvae counts per goat varied with the monthly prevalence.

Sero-prevalence of avian influenza among broiler-breeder flocks in Jordan.

Thirty blood samples were collected randomly from each of the 38 breeder-broiler farms in Jordan. Serum samples were examined using indirect ELISA for specific antibodies to avian influenza virus. The overall true flock-level sero-prevalence of avian influenza was 71% (95% CI: 55,83). Positive flocks had 2-30 sero-positive chickens and half of flocks had >20 sero-positive birds. The number of sero-positive flocks varied in the studied localities with more sero-positives in farms located within the migratory route of migratory wild fowl. The examined broiler-breeder flocks had no clinical signs, or noticeable decrease in egg production; mortalities were within the normal range (0.1-1%). The number of positive sera/flock correlated with flock size. There were a no significant (Pearsons r=0.21, p=0.21) correlation between positive flocks and age. A non-pathogenic AI virus infects broiler-breeder farms in Jordan. Wild local and migrating birds might promote the further spread of this virus in Jordan and other countries.

Oestrus ovis larval myiasis among goats in northern Jordan.

From December 1998 to December 1999, heads of 520 local goats slaughtered at the Irbid, Ramtha and Howarra Abattoirs (northern Jordan) were examined for the three larval instars (L(1)-L(3)) of Oestrus ovis. Of 520 heads, 126 (24%) were infested with O. ovis larvae. All three larval instars were observed in both sexes; all age groups were infested in each month of the year. The mean age of the goats sampled was 1.5 years. The numbers of parasites infesting hosts showed a significant (P<0.05) correlation with sheep age (r(sp)=0.31-0.42) for all three larval instars. The numbers of larvae in each host followed an overdispersed distribution, which fit a negative-binomial model (but not a Poisson distribution). There were more parasites recorded in the presence of purulent discharge or laryngitis, fewer in the presence of catarrhal discharge and no association with pharyngitis sinusitis, or rhinitis.

Prevalence of Taenia multiceps in sheep in northern Jordan.

From March 1996 to February 1997, slaughtered-sheeps' heads were examined for the metacestode of Taenia multiceps. Out of 451 sheep heads, only 12 (3%) were infested. All cysts but one were in the age group 0.5-2.5 years old, with prevalence of 10% (11 of 108). Eleven of 12 infested heads were found during the spring and autumn seasons. Out of 95 flocks involved in questionnaire survey unrelated to the abattoir survey, all the farmers reported the existence of the clinical signs known for coenurosis and described it in locally known names and diseases. Twenty-five of them had recent cases that were diagnosed by the veterinarian as coenurosis cases. Each flock reported one or two cases at the time of survey. A variety of clinical signs were reported from these cases (n = 42). These included circling (86%), head pressing (52%), blindness (29%) and paresis (40%). Coenurosis is a sheep-health problem and an important cause of sheep culling in Jordan.

Flock-level prevalence of Eimeria species among broiler chicks in northern Jordan.

Six chicks (3-6 weeks of age) were taken randomly from each of 200 broiler farms in northern Jordan, these chicks were submitted for post-mortem and parasitological examinations. Seven Eimeria spp. were identified: E. acervulina, E. brunetti, E. maxima, E. necatrix, E. mivati, E. mitis, and E. tenella. Half (50%) of the farms surveyed had all six chicks infected, 23% of the farms were free of the infection. E. tenella was the most prevalent species (39%) followed by E. necatrix (12%), E. brunitti (12%), and E. maxima (10%). Prevalences did not vary by flock size. Also, neither the use of coccidiostat nor previous coccidiosis clinical outbreaks was associated with the prevalence of coccidiosis.